A Study On Incidence Of Cystic Kidney Disease In Patients On Maintenance Hemodialysis

ABSTRACT

INTRODUCTION: Cystic kidney disease is a unilateral or bilateral cystic disease characterized by small cysts distributed throughout the renal cortex and medulla of patients with ESRD unrelated to inherited renal cystic diseases. ACKD is a disease of chronic renal failure of any etiology and has to be differentiated from other types of cystic kidney disease. It is defined as more than three macroscopic cysts in each kidney of a patient who does not have a hereditary cause of cystic disease. It can be present at early stages of CKD or more commonly in patients on dialysis & to a lesser extent in native kidneys of renal transplant recipients. Most of them are asymptomatic but rarely complications like infection, rupture, bleeding, spontaneous perinephric hematoma may occur There is increased incidence of renal neoplasms in acquired cystic kidney disease that some authors consider ACKD pre-neoplastic. 1 Its prevalence and severity are higher in men than in women and increases with the duration of azotemia and duration of dialysis as well. With better health care facilities and penetration of nephrology services, the life span of patients on dialysis is increasing. The easy availability & application of imaging services to the above group has led to more frequent diagnosis of acquired cystic kidney disease. AIMS:To study the prevalence of kidney cysts in patients on maintenance hemodialysis. OBJECTIVES: Ÿ To study correlation between duration of dialysis and cystic changes and complications arising out it. Ÿ To study the impact of age and gender on cystic changes. METHODS:The study was done in Maintenance hemodialysis unit of Gandhi Hospital, secunderabad. 140 patients were enrolled over a period of one year from May,2016 to April,2017. Patients who had past history of polycystic kidney disease and had acquired kidney disease on sonography prior to dialysis were excluded. Radiological imaging was done using Computerized tomography KUB to look for acquired renal cysts. Cystic changes were considered as presence of one or more cysts in either or both the kidneys. STUDYDESIGN: prospective cross-sectional observational study. STATISTICALMETHODS: Data analysed using the Statistical Package for Social Science (SPSS) software version 19. ANOVAtest is applied for comparison variables. APvalue of < 0.05 is taken as significant. RESULTS: 22.8% of the incident MHD cohort were found to have cystic changes, of which 78.1% constitute males and 21.8% females. Cystic changes were observed in 46.6%in patients on MHD between 4-5yrs, 57.6% in patients on MHD between 5-6 yrs and to 75%in patients on MHD greater than 6 yrs. CONCLUSION: This study showed that Cystic kidney disease is an important complication of long term HD regardless of etiology of renal failure, more seen in males and relates to duration of hemodialysis. Hence renal surveillance with USG or CT every 3yrs in all dialysis patients and annually in patients with cystic changes.